糖尿病酮症酸中毒合并急性心肌梗死14例临床分析

目的 探讨糖尿病酮症酸中毒(DKA)合并急性心肌梗死(AMI)的发病情况及临床特点.方法 回顾性分析我院1998～2006年共14例2型糖尿病酮症酸中毒合并AMI患者的临床资料.结果 1998～2006年共检出DKA合并AMI患者14例;发病时同时诊断DKA合并AMI者11例,占79%;先出现DKA后出现AMI者3例,占21%;DKA合并AMI发病时以气促、消化道症状和糖尿病典型"三多"症状多见,伴随胸痛者只有29%;心电图表现为非ST段抬高性心肌梗死(NSTEMI)者6例,占43%;所有患者发病时心功能均明显降低,Killip分级3～4级者占71%;治疗上均按DKA和AMI原则处理,但限制补液量,14例患者中经抢救治疗后8例死亡(57%),含3例合并慢性肾衰竭尿毒症患者.结论 DKA合并AMI患者AMI多与DKA同时发生亦可后发,且AMI表现多不典型,发病时心功能差,病死率高.

The clinical analysis on 14 cases of diabetic ketoacidosis with acute myocardial infarction

Objective To investigate the clinical features of diabetic ketoacidocsis(DKA)complicated with acute myocardial infarction(AMI).Methods Fourteen cases of DKA patients complicated with AMI who had been diagnosed with Type 2 diabetes mellitus(T2DM)between 1998 to 2006 in our hospital were retrospectively analyzed.Results Eleven cases(79%)of AMI were diagnosed at the same time with DKA,3 cases(21%)later than DKA.Patients with DKA manifested dyspnea,digestive symptoms and the classic symptoms of diabetes mellitus at onset of AMI,only 29% patients presented with chest pain.In 6 cases(43%)non-STEMI(NSTEMI)were diagnosed by ECG feature.All patients were suffering from heart insufficiency,in which 71% were 3 or 4 grade according to Killip classification.The therapeutic methods of DKA and AMI were adopted,but fluid replacement was restricted.six patients(43%)recovered while 8 patients(57%)died,including 3 cases complicated with chronic renal failure,after emergency treatment.Conclusions:AMI may cooccur at the same time with DKA or later than DKA.The DKA patients complicated with AMI are more likely to experience atypical symptoms and have been suffering from serious cardiac insufficiency,and there is a high mortality in these patients.